Welcome to the Acci

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Welcome to the Acción Mutua web-seminarUnderstan
ding Transgender Latinas and other Transgender
Women of Color and their HIV Concerns

• Presentation by seminar speaker (approx. 40 min.)
• Followed by question and answer session (approx.
  20 min.)
• 
  
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• Questions submitted prior to the web-seminar will
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  click on the hand button and type your question
  or wait to be called on to ask your question over
  the phone during the QA

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• Acción Mutua is a capacity building assistance
  (CBA) program of AIDS Project Los Angeles in
  collaboration with the César E. Chávez Institute
  of San Francisco State University
• Funded by the Centers for Disease Control and
  Prevention

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Understanding Transgender Latinas and other
Transgender Women of Color and their HIV Concerns
Presented by JoAnne Keatley, MSW Pacific AIDS
Education Training Center University of
California, San Francisco
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(No Transcript)
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Todays Web-Seminar Objectives

• Understand the impact of bias on the healthcare
  experiences and choices of transgender
  populations
• Identify ways to design and deliver
  gender-appropriate and culturally competent
  services for transgender clients
• Discuss strategies for effective outreach to and
  engagement of the transgender population

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Transgender?

• When you hear the term transgender who/what
  comes to mind?
• What do you know about transgender people?
• What types of contact have you had with
  transgender people?
• What more do you want to know about transgender
  people?

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Gender Sex
traditional woman
traditional
man
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Gender Sex

• Binary Gender System The societal division of
  human beings into two, distinct categories of
  male and female.
• Chromosomes Genetic material that carry the
  genes that determine height, eye color, etc. Two
  of them are related to biological sex. XX and XY.
• Intersex Can include individuals who are born
  with genes other than XX or XY may have
  ambiguous genitalia. ISNA 1 in 2000 people
  have some form of an Intersex condition

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Gender Sex

• Biological Sex. The sex assigned at birth
  typically based on examination of the genitals.
• Gender Identity Self-image or belief a person
  has about their gender as being female, male, or
  something altogether different.
• Sexual Orientation The internal experience that
  determines who we are physically and/or
  emotionally attracted to.

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Transgender People

• May undergo surgical and/or hormonal treatment to
  change their physical appearance and/or gender
  expression.
• Often adopt a new name and lifestyle to reflect
  their gender identity.
• Are sexually diverse, important not to make
  assumptions.

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Epidemiology

• Rates of HIV infection estimates
• 13 68 for transgender women
• 2 3 for transgender men
• Rates are higher for transgender people who are
• Male to Female
• Of Color
• Engage in sex work
• Use injection drugs

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Gender-Specific of HIV/AIDS Cases Younger than
30
Race/Ethnicity Male Female
Transgender
HIV AIDS HIV AIDS HIV AIDS
African American 26.8 15.5 32.1 19.7 37.2 17.8
Asian/PI 30.9 16.1 42.1 22.3 52.4 31.9
Hispanic/Latino 40.0 23.0 47.9 29.6 52.0 31.0
Native American 34.5 21.9 35.6 24.1 28.6 N/A
White 21.6 12.2 32.9 20.7 32.7 18.4
Includes only HIV cases reported via non-name
code Mathew Facer, Epidemiologic Studies Section,
California Office of AIDS
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HIV Risk Behaviors among MTF Transgenders of
Color Tooru Nemoto, PhD., Principal
Investigator Don Operario, PhD. Research
Associate JoAnne Keatley, MSW, Project
Director Center for AIDS Prevention Studies,
UCSF Supported by National Institute on Drug
Abuse (NIDA) (Grant No ROI DA11589-05)
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• We examined HIV-related risk behaviors among
  samples of African American, Latina, and Asian
  Pacific Islander transgenders in San Francisco.
• In our study we focused on specific HIV-risk
  behaviors such as
• Sexual Behaviors primary, casual, and
  commercial
• Health Outcomes HIV/STD, depression, need and
  access to care
• Substance Use (lifetime, past 30 days),
  injection drug use, engaged in sex with primary,
  casual, or commercial partners while under the
  influence of any illicit drugs
• Psychosocial Factors transphobia, depression,
  self-esteem, gender identity, social support

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Table 1. Demographics by Ethnicity
Total (n332) N () Afri.Am. (n112) N () Latina (n110) N () API (n110) N ()
Income source(s) in past 6 months Full time job Prostitution Income in past 30 days () 0-499 500-999 1,000-1,999 2,000 (and above) 92 (28) 170 (51) 64 (20) 110 (34) 70 (21) 84 (26) 18 (16) 56 (50) 15 (13) 51 (46) 31 (28) 15 (13) 24 (22) 79 (72) 36 (33) 35 (32) 15 (14) 22 (20) 50 (45) 35 (32) 13 (12) 24 (22) 24 (22) 47 (44)
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Table 2. HIV/STD by Ethnicity
Total (n332) N () Afri. Am. (n112) N () Latina (n110) N () API (n110) N ()
HIV Positive Status 86 (26) 47 (41) 25 (23) 14 (13)
Any STD, past 12 months 46 (14) 20 (18) 21 (19) 5 (4)
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Major Findings

• About three-quarters of the participants had
  recently engaged in receptive anal sex.
• A significantly higher proportion (47)had
  recently engaged in URAS with primary partners
  than with casual (26) and commercial partners
  (12).
• Current URAS with primary and casual partners,
  but not commercial partners, was significantly
  and independently correlated with having had sex
  under the influence
• HIV positive participants were 3.8 times more
  likely to engage in receptive anal sex as well as
  URAS with casual partners than HIV negative
  participants, controlling for other variables.

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• Major Findings, continued
• Although only 12 had reported URAS with
  commercial partners in the past 30 days, this
  risk behavior was significantly and independently
  correlated with African American race (4.5 times
  more compared with non-African Americans) and
  lowest income level (less than 500 of monthly
  income).
• Nemoto T, Operario D, Keatley J, Han L, Soma T.
  (2004). HIV Risk Behaviors Among Male-to-Female
  Transgender Persons of Color in San Francisco.
  American Journal of Public Health, Vol.94, No.7,
  1193-1199

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Barriers to Service

• Lack of information on risk for trans people
• Misinformation within trans community
• Low perception of risks
• Data collection has ignored various trans
  identities.
• Prevalence drives funding and programs
• FTM incidence not well understood or explored
• TG women continue to be counted in MSM category
  for funding and prevention programs

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Barriers to Care Providers

• Lack of knowledge and information
• Personal discomfort
• Lack of clinical research, literature
• Lack of agency support
• Not enough people doing the work
• Religious/Moral concerns

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Barriers to Care Clients

• Fear of disclosure/exposure
• Social and geographic isolation
• History of bad experiences with care providers
• Intake forms, office environment, alienating
  process
• Lack of insurance coverage
• Trans-related care is often explicitly denied in
  insurance policies.

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HIV and Hormones

• There are no significant drug interactions with
  drugs used to treat HIV.
• Several HIV medications change the levels of
  estrogens.
• Cross gender hormone therapy is not
  contraindicated in HIV disease at any stage.
• Transgender patients need ongoing care, not just
  access to hormones.

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Suggestions for Making Your Agency Trans Affirming

• Dont just add a T, implement non
  discriminatory policies and procedures.
• Provide training for all staff front office,
  managers, security guards, counselors, outreach
  staff
• Make intake forms trans inclusive
• include preferred name not just legal name
• include more gender choices
• Challenge transphobiain staff and community
• Have trans-inclusive imagery in waiting room
• Use inclusive or gender neutral language
• Create safe bathroom policies!
• Hire Transgender people!!!!!!!!!!!

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Costura y Charla (Spanish-language
Sewing/Support Group)

• Support group and skills-building class for
  Spanish Speaking transgender women
• Facilitated by Transgender Health Educators and a
  Consultant

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Costura y Charla continued

• During support sessions, participants received
  training in pattern making, design, cutting
  fabric, sewing clothes and alterations.
• HIV/AIDS prevention, relationships with family,
  friends and lovers as well as other issues that
  effect the Latino transgender community.
• Skill building as well as emotional support in a
  culturally appropriate environment

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Costura y Charla
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Costura y Charla
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Costura y Charla
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Thank You!   Comments Discussion
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• JoAnne Keatley, MSW
• Joanne.keatley_at_ucsf.edu
• 415.597.4960
• For more information on how to receive CBA
  services please contact
• Acción Mutua (Western region Latino CBA
  provider)
• 213.201.1345 or www.accionmutua.org
• Transitions (nation-wide transgender CBA
  provider)
• j.sevelius_at_ucsf.edu
• www.caps.ucsf.edu/projects/Transitions/